Workers Compensation Claims Analyst

Job Description

Location: Jacksonville, FL (Greater Metro Area)

We are seeking a Workers Compensation Claims Analyst to manage the adjudication, follow-up, and resolution of workers comp claims for occupational health and employee injury cases. This role ensures accurate billing, timely reimbursement, and compliance with state-specific workers compensation regulations that differ significantly from standard medical billing.

Workers comp billing is a specialty within a specialty. The rules are different. The fee schedules are different. The appeals processes are different. And the stakes are high because every delay in payment directly impacts both the injured worker and the organization. If you understand this world and know how to navigate it efficiently, this role needs your expertise.

Responsibilities:

• Process and adjudicate workers compensation claims from initial filing through final payment resolution
• Verify employer coverage, claim jurisdiction, and injury date eligibility for each case
• Review medical documentation to ensure treatment aligns with authorized injury claims and treatment guidelines
• Submit claims to workers comp carriers and state funds using appropriate billing formats and fee schedules
• Follow up on unpaid and underpaid claims through carrier portals, phone outreach, and written correspondence
• Manage denied claims through the dispute resolution and appeals process specific to workers compensation
• Maintain compliance with Florida workers compensation statutes and billing regulations
• Coordinate with case managers, attorneys, and adjusters to resolve complex claim issues
• Track claim status across multiple carriers and self-insured employers simultaneously
• Process first reports of injury and ensure timely filing within state-mandated deadlines
• Verify treatment authorization and utilization review decisions before billing
• Manage impairment rating and maximum medical improvement documentation for claim closure
• Support subrogation and lien resolution activities as needed
• Maintain knowledge of state-specific workers comp fee schedules, treatment guidelines, and regulatory updates

Qualifications:

• High school diploma required; associate degree in healthcare or business preferred
• Minimum 2 years of workers compensation claims processing or medical billing experience
• Knowledge of state workers comp fee schedules, billing codes, and regulatory requirements
• Familiarity with workers comp billing software and carrier portals
• Understanding of CPT, ICD-10, and occupational health documentation standards
• Strong organizational skills and attention to detail in high-volume claims environments
• Knowledge of Florida workers compensation statutes and dispute resolution processes
• Ability to manage multiple concurrent claims across different carriers and jurisdictions

Schedule:

• Full-time position
• Standard business hours
• Standard full-time hours per pay period

Salary Range: The salary range for this position is approximately $44,000 – $56,000 annually ($21.15 – $26.92 per hour), based on experience and qualifications. Relocation assistance may be available for qualified candidates.

Interview Process:

• Selected candidates will participate in a multi-step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and prohibits discrimination and harassment of any kind. We are dedicated to building a diverse workforce and fostering an inclusive work environment where all employees and candidates are treated with respect and dignity. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or any other protected status under applicable law. We actively seek to recruit, develop, and retain talented individuals from diverse backgrounds and we encourage all qualified candidates to apply for our job opportunities.